|
HC INJECTION FACET JOINT L OR S 3RD + LEVEL BIL
|
Facility
|
OP
|
$617.71
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
36100631
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$146.71 |
| Max. Negotiated Rate |
$555.94 |
| Rate for Payer: Aetna Commercial |
$525.05
|
| Rate for Payer: Aetna Medicare |
$160.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$193.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$193.03
|
| Rate for Payer: BCBS Complete |
$247.08
|
| Rate for Payer: BCBS MAPPO |
$154.43
|
| Rate for Payer: BCBS Trust/PPO |
$507.82
|
| Rate for Payer: BCN Commercial |
$480.27
|
| Rate for Payer: BCN Medicare Advantage |
$154.43
|
| Rate for Payer: Cash Price |
$494.17
|
| Rate for Payer: Cofinity Commercial |
$531.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$494.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.43
|
| Rate for Payer: Healthscope Commercial |
$555.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$463.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$525.05
|
| Rate for Payer: Nomi Health Commercial |
$506.52
|
| Rate for Payer: PACE Senior Care Partners |
$146.71
|
| Rate for Payer: PACE SWMI |
$154.43
|
| Rate for Payer: PHP Commercial |
$525.05
|
| Rate for Payer: PHP Medicare Advantage |
$154.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.51
|
| Rate for Payer: Priority Health HMO/PPO |
$537.41
|
| Rate for Payer: Priority Health Medicare |
$155.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$413.87
|
| Rate for Payer: Railroad Medicare Medicare |
$154.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$543.58
|
| Rate for Payer: UHC Core |
$515.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$154.43
|
| Rate for Payer: UHC Exchange |
$154.43
|
| Rate for Payer: UHC Medicare Advantage |
$154.43
|
| Rate for Payer: VA VA |
$154.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$463.28
|
|
|
HC INJECTION FACET JOINT L OR S 3RD + LEVEL BIL
|
Facility
|
IP
|
$617.71
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
36100631
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$401.51 |
| Max. Negotiated Rate |
$555.94 |
| Rate for Payer: Aetna Commercial |
$525.05
|
| Rate for Payer: BCBS Trust/PPO |
$504.24
|
| Rate for Payer: BCN Commercial |
$477.37
|
| Rate for Payer: Cash Price |
$494.17
|
| Rate for Payer: Cofinity Commercial |
$531.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$494.17
|
| Rate for Payer: Healthscope Commercial |
$555.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$463.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$525.05
|
| Rate for Payer: Nomi Health Commercial |
$506.52
|
| Rate for Payer: PHP Commercial |
$525.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.51
|
| Rate for Payer: Priority Health HMO/PPO |
$537.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$413.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$543.58
|
| Rate for Payer: UHC Core |
$515.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$463.28
|
|
|
HC INJECTION FOR CEREBRAL SHUNT
|
Facility
|
IP
|
$826.35
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
36100270
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$537.13 |
| Max. Negotiated Rate |
$743.72 |
| Rate for Payer: Aetna Commercial |
$702.40
|
| Rate for Payer: BCBS Trust/PPO |
$674.55
|
| Rate for Payer: BCN Commercial |
$638.60
|
| Rate for Payer: Cash Price |
$661.08
|
| Rate for Payer: Cofinity Commercial |
$710.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$661.08
|
| Rate for Payer: Healthscope Commercial |
$743.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$619.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$702.40
|
| Rate for Payer: Nomi Health Commercial |
$677.61
|
| Rate for Payer: PHP Commercial |
$702.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$537.13
|
| Rate for Payer: Priority Health HMO/PPO |
$718.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$553.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$727.19
|
| Rate for Payer: UHC Core |
$690.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$619.76
|
|
|
HC INJECTION FOR CEREBRAL SHUNT
|
Facility
|
OP
|
$826.35
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
36100270
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$196.26 |
| Max. Negotiated Rate |
$743.72 |
| Rate for Payer: Aetna Commercial |
$702.40
|
| Rate for Payer: Aetna Medicare |
$214.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$258.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$258.23
|
| Rate for Payer: BCBS Complete |
$525.76
|
| Rate for Payer: BCBS MAPPO |
$206.59
|
| Rate for Payer: BCBS Trust/PPO |
$679.34
|
| Rate for Payer: BCN Commercial |
$642.49
|
| Rate for Payer: BCN Medicare Advantage |
$206.59
|
| Rate for Payer: Cash Price |
$661.08
|
| Rate for Payer: Cash Price |
$661.08
|
| Rate for Payer: Cofinity Commercial |
$710.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$661.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$206.59
|
| Rate for Payer: Healthscope Commercial |
$743.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$619.76
|
| Rate for Payer: Mclaren Medicaid |
$500.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$216.92
|
| Rate for Payer: Meridian Medicaid |
$525.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$237.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$702.40
|
| Rate for Payer: Nomi Health Commercial |
$677.61
|
| Rate for Payer: PACE Senior Care Partners |
$196.26
|
| Rate for Payer: PACE SWMI |
$206.59
|
| Rate for Payer: PHP Commercial |
$702.40
|
| Rate for Payer: PHP Medicare Advantage |
$206.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$500.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$537.13
|
| Rate for Payer: Priority Health HMO/PPO |
$718.92
|
| Rate for Payer: Priority Health Medicare |
$208.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$553.65
|
| Rate for Payer: Railroad Medicare Medicare |
$206.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$727.19
|
| Rate for Payer: UHC Core |
$690.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$206.59
|
| Rate for Payer: UHC Exchange |
$206.59
|
| Rate for Payer: UHC Medicare Advantage |
$206.59
|
| Rate for Payer: UHCCP Medicaid |
$500.69
|
| Rate for Payer: VA VA |
$206.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$619.76
|
|
|
HC INJECTION FOR HYSTEROSALPINGOGRAM
|
Facility
|
OP
|
$656.49
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
36100256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$155.92 |
| Max. Negotiated Rate |
$590.84 |
| Rate for Payer: Aetna Commercial |
$558.02
|
| Rate for Payer: Aetna Medicare |
$170.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$205.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$205.15
|
| Rate for Payer: BCBS Complete |
$262.60
|
| Rate for Payer: BCBS MAPPO |
$164.12
|
| Rate for Payer: BCBS Trust/PPO |
$539.70
|
| Rate for Payer: BCN Commercial |
$510.42
|
| Rate for Payer: BCN Medicare Advantage |
$164.12
|
| Rate for Payer: Cash Price |
$525.19
|
| Rate for Payer: Cofinity Commercial |
$564.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$525.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$164.12
|
| Rate for Payer: Healthscope Commercial |
$590.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$492.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$172.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$558.02
|
| Rate for Payer: Nomi Health Commercial |
$538.32
|
| Rate for Payer: PACE Senior Care Partners |
$155.92
|
| Rate for Payer: PACE SWMI |
$164.12
|
| Rate for Payer: PHP Commercial |
$558.02
|
| Rate for Payer: PHP Medicare Advantage |
$164.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$426.72
|
| Rate for Payer: Priority Health HMO/PPO |
$571.15
|
| Rate for Payer: Priority Health Medicare |
$165.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$439.85
|
| Rate for Payer: Railroad Medicare Medicare |
$164.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$577.71
|
| Rate for Payer: UHC Core |
$548.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$164.12
|
| Rate for Payer: UHC Exchange |
$164.12
|
| Rate for Payer: UHC Medicare Advantage |
$164.12
|
| Rate for Payer: VA VA |
$164.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$492.37
|
|
|
HC INJECTION FOR HYSTEROSALPINGOGRAM
|
Facility
|
IP
|
$656.49
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
36100256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$426.72 |
| Max. Negotiated Rate |
$590.84 |
| Rate for Payer: Aetna Commercial |
$558.02
|
| Rate for Payer: BCBS Trust/PPO |
$535.89
|
| Rate for Payer: BCN Commercial |
$507.34
|
| Rate for Payer: Cash Price |
$525.19
|
| Rate for Payer: Cofinity Commercial |
$564.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$525.19
|
| Rate for Payer: Healthscope Commercial |
$590.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$492.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$558.02
|
| Rate for Payer: Nomi Health Commercial |
$538.32
|
| Rate for Payer: PHP Commercial |
$558.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$426.72
|
| Rate for Payer: Priority Health HMO/PPO |
$571.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$439.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$577.71
|
| Rate for Payer: UHC Core |
$548.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$492.37
|
|
|
HC INJECTION HIP ARTHROGRAM
|
Facility
|
OP
|
$1,309.24
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
36100040
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$310.94 |
| Max. Negotiated Rate |
$1,178.32 |
| Rate for Payer: Aetna Commercial |
$1,112.85
|
| Rate for Payer: Aetna Medicare |
$340.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$409.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$409.14
|
| Rate for Payer: BCBS Complete |
$523.70
|
| Rate for Payer: BCBS MAPPO |
$327.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,076.33
|
| Rate for Payer: BCN Commercial |
$1,017.93
|
| Rate for Payer: BCN Medicare Advantage |
$327.31
|
| Rate for Payer: Cash Price |
$1,047.39
|
| Rate for Payer: Cofinity Commercial |
$1,125.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,047.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$327.31
|
| Rate for Payer: Healthscope Commercial |
$1,178.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$981.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$343.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$376.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,112.85
|
| Rate for Payer: Nomi Health Commercial |
$1,073.58
|
| Rate for Payer: PACE Senior Care Partners |
$310.94
|
| Rate for Payer: PACE SWMI |
$327.31
|
| Rate for Payer: PHP Commercial |
$1,112.85
|
| Rate for Payer: PHP Medicare Advantage |
$327.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$851.01
|
| Rate for Payer: Priority Health HMO/PPO |
$1,139.04
|
| Rate for Payer: Priority Health Medicare |
$330.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$877.19
|
| Rate for Payer: Railroad Medicare Medicare |
$327.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,152.13
|
| Rate for Payer: UHC Core |
$1,093.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$327.31
|
| Rate for Payer: UHC Exchange |
$327.31
|
| Rate for Payer: UHC Medicare Advantage |
$327.31
|
| Rate for Payer: VA VA |
$327.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$981.93
|
|
|
HC INJECTION HIP ARTHROGRAM
|
Facility
|
IP
|
$1,309.24
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
36100040
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$851.01 |
| Max. Negotiated Rate |
$1,178.32 |
| Rate for Payer: Aetna Commercial |
$1,112.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,068.73
|
| Rate for Payer: BCN Commercial |
$1,011.78
|
| Rate for Payer: Cash Price |
$1,047.39
|
| Rate for Payer: Cofinity Commercial |
$1,125.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,047.39
|
| Rate for Payer: Healthscope Commercial |
$1,178.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$981.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,112.85
|
| Rate for Payer: Nomi Health Commercial |
$1,073.58
|
| Rate for Payer: PHP Commercial |
$1,112.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$851.01
|
| Rate for Payer: Priority Health HMO/PPO |
$1,139.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$877.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,152.13
|
| Rate for Payer: UHC Core |
$1,093.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$981.93
|
|
|
HC INJECTION HIP ARTHROGRAM BIL
|
Facility
|
OP
|
$1,214.02
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
36100041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$288.33 |
| Max. Negotiated Rate |
$1,092.62 |
| Rate for Payer: Aetna Commercial |
$1,031.92
|
| Rate for Payer: Aetna Medicare |
$315.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.38
|
| Rate for Payer: BCBS Complete |
$485.61
|
| Rate for Payer: BCBS MAPPO |
$303.50
|
| Rate for Payer: BCBS Trust/PPO |
$998.05
|
| Rate for Payer: BCN Commercial |
$943.90
|
| Rate for Payer: BCN Medicare Advantage |
$303.50
|
| Rate for Payer: Cash Price |
$971.22
|
| Rate for Payer: Cofinity Commercial |
$1,044.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$971.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.50
|
| Rate for Payer: Healthscope Commercial |
$1,092.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$910.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,031.92
|
| Rate for Payer: Nomi Health Commercial |
$995.50
|
| Rate for Payer: PACE Senior Care Partners |
$288.33
|
| Rate for Payer: PACE SWMI |
$303.50
|
| Rate for Payer: PHP Commercial |
$1,031.92
|
| Rate for Payer: PHP Medicare Advantage |
$303.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$789.11
|
| Rate for Payer: Priority Health HMO/PPO |
$1,056.20
|
| Rate for Payer: Priority Health Medicare |
$306.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$813.39
|
| Rate for Payer: Railroad Medicare Medicare |
$303.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,068.34
|
| Rate for Payer: UHC Core |
$1,013.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.50
|
| Rate for Payer: UHC Exchange |
$303.50
|
| Rate for Payer: UHC Medicare Advantage |
$303.50
|
| Rate for Payer: VA VA |
$303.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$910.51
|
|
|
HC INJECTION HIP ARTHROGRAM BIL
|
Facility
|
IP
|
$1,214.02
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
36100041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$789.11 |
| Max. Negotiated Rate |
$1,092.62 |
| Rate for Payer: Aetna Commercial |
$1,031.92
|
| Rate for Payer: BCBS Trust/PPO |
$991.00
|
| Rate for Payer: BCN Commercial |
$938.19
|
| Rate for Payer: Cash Price |
$971.22
|
| Rate for Payer: Cofinity Commercial |
$1,044.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$971.22
|
| Rate for Payer: Healthscope Commercial |
$1,092.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$910.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,031.92
|
| Rate for Payer: Nomi Health Commercial |
$995.50
|
| Rate for Payer: PHP Commercial |
$1,031.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$789.11
|
| Rate for Payer: Priority Health HMO/PPO |
$1,056.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$813.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,068.34
|
| Rate for Payer: UHC Core |
$1,013.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$910.51
|
|
|
HC INJECTION INTRALESIONAL UP TO 7 LESIONS
|
Facility
|
OP
|
$147.11
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
76100134
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.94 |
| Max. Negotiated Rate |
$150.85 |
| Rate for Payer: Aetna Commercial |
$125.04
|
| Rate for Payer: Aetna Medicare |
$38.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.97
|
| Rate for Payer: BCBS Complete |
$150.85
|
| Rate for Payer: BCBS MAPPO |
$36.78
|
| Rate for Payer: BCBS Trust/PPO |
$120.94
|
| Rate for Payer: BCN Commercial |
$114.38
|
| Rate for Payer: BCN Medicare Advantage |
$36.78
|
| Rate for Payer: Cash Price |
$117.69
|
| Rate for Payer: Cash Price |
$117.69
|
| Rate for Payer: Cofinity Commercial |
$126.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.78
|
| Rate for Payer: Healthscope Commercial |
$132.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.33
|
| Rate for Payer: Mclaren Medicaid |
$143.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.62
|
| Rate for Payer: Meridian Medicaid |
$150.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.04
|
| Rate for Payer: Nomi Health Commercial |
$120.63
|
| Rate for Payer: PACE Senior Care Partners |
$34.94
|
| Rate for Payer: PACE SWMI |
$36.78
|
| Rate for Payer: PHP Commercial |
$125.04
|
| Rate for Payer: PHP Medicare Advantage |
$36.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.62
|
| Rate for Payer: Priority Health HMO/PPO |
$127.99
|
| Rate for Payer: Priority Health Medicare |
$37.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.56
|
| Rate for Payer: Railroad Medicare Medicare |
$36.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.46
|
| Rate for Payer: UHC Core |
$122.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.78
|
| Rate for Payer: UHC Exchange |
$36.78
|
| Rate for Payer: UHC Medicare Advantage |
$36.78
|
| Rate for Payer: UHCCP Medicaid |
$143.66
|
| Rate for Payer: VA VA |
$36.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.33
|
|
|
HC INJECTION INTRALESIONAL UP TO 7 LESIONS
|
Facility
|
IP
|
$147.11
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
76100134
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.62 |
| Max. Negotiated Rate |
$132.40 |
| Rate for Payer: Aetna Commercial |
$125.04
|
| Rate for Payer: BCBS Trust/PPO |
$120.09
|
| Rate for Payer: BCN Commercial |
$113.69
|
| Rate for Payer: Cash Price |
$117.69
|
| Rate for Payer: Cofinity Commercial |
$126.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.69
|
| Rate for Payer: Healthscope Commercial |
$132.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.04
|
| Rate for Payer: Nomi Health Commercial |
$120.63
|
| Rate for Payer: PHP Commercial |
$125.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.62
|
| Rate for Payer: Priority Health HMO/PPO |
$127.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.46
|
| Rate for Payer: UHC Core |
$122.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.33
|
|
|
HC INJECTION, IRON DEXTRAN, 50 MG
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT J1750
|
| Hospital Charge Code |
63600097
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.57 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: BCBS Trust/PPO |
$50.95
|
| Rate for Payer: BCN Commercial |
$48.24
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health HMO/PPO |
$54.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.93
|
| Rate for Payer: UHC Core |
$52.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.81
|
|
|
HC INJECTION, IRON DEXTRAN, 50 MG
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
CPT J1750
|
| Hospital Charge Code |
63600097
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.09 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna Medicare |
$16.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.51
|
| Rate for Payer: BCBS Complete |
$13.75
|
| Rate for Payer: BCBS MAPPO |
$15.61
|
| Rate for Payer: BCBS Trust/PPO |
$51.32
|
| Rate for Payer: BCN Commercial |
$48.53
|
| Rate for Payer: BCN Medicare Advantage |
$15.61
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.61
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.81
|
| Rate for Payer: Mclaren Medicaid |
$13.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.39
|
| Rate for Payer: Meridian Medicaid |
$13.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: PACE Senior Care Partners |
$14.82
|
| Rate for Payer: PACE SWMI |
$15.61
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: PHP Medicare Advantage |
$15.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health HMO/PPO |
$54.31
|
| Rate for Payer: Priority Health Medicare |
$15.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.82
|
| Rate for Payer: Railroad Medicare Medicare |
$15.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.93
|
| Rate for Payer: UHC Core |
$52.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.61
|
| Rate for Payer: UHC Exchange |
$15.61
|
| Rate for Payer: UHC Medicare Advantage |
$15.61
|
| Rate for Payer: UHCCP Medicaid |
$13.09
|
| Rate for Payer: VA VA |
$15.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.81
|
|
|
HC INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT J1885
|
| Hospital Charge Code |
63600098
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$5.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.50
|
| Rate for Payer: BCBS Complete |
$0.23
|
| Rate for Payer: BCBS MAPPO |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$17.11
|
| Rate for Payer: BCN Commercial |
$16.18
|
| Rate for Payer: BCN Medicare Advantage |
$5.20
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.20
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Mclaren Medicaid |
$0.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.46
|
| Rate for Payer: Meridian Medicaid |
$0.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PACE Senior Care Partners |
$4.94
|
| Rate for Payer: PACE SWMI |
$5.20
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: PHP Medicare Advantage |
$5.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO |
$18.10
|
| Rate for Payer: Priority Health Medicare |
$5.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.94
|
| Rate for Payer: Railroad Medicare Medicare |
$5.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.31
|
| Rate for Payer: UHC Core |
$17.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.20
|
| Rate for Payer: UHC Exchange |
$5.20
|
| Rate for Payer: UHC Medicare Advantage |
$5.20
|
| Rate for Payer: UHCCP Medicaid |
$0.22
|
| Rate for Payer: VA VA |
$5.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT J1885
|
| Hospital Charge Code |
63600098
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: BCBS Trust/PPO |
$16.99
|
| Rate for Payer: BCN Commercial |
$16.08
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO |
$18.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.31
|
| Rate for Payer: UHC Core |
$17.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC INJECTION, LINCOMYCIN HCL, UP TO 300 MG
|
Facility
|
OP
|
$45.78
|
|
|
Service Code
|
CPT J2010
|
| Hospital Charge Code |
63600099
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.87 |
| Max. Negotiated Rate |
$41.20 |
| Rate for Payer: Aetna Commercial |
$38.91
|
| Rate for Payer: Aetna Medicare |
$11.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.31
|
| Rate for Payer: BCBS Complete |
$18.31
|
| Rate for Payer: BCBS MAPPO |
$11.45
|
| Rate for Payer: BCBS Trust/PPO |
$37.64
|
| Rate for Payer: BCN Commercial |
$35.59
|
| Rate for Payer: BCN Medicare Advantage |
$11.45
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Commercial |
$39.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.45
|
| Rate for Payer: Healthscope Commercial |
$41.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: Nomi Health Commercial |
$37.54
|
| Rate for Payer: PACE Senior Care Partners |
$10.87
|
| Rate for Payer: PACE SWMI |
$11.45
|
| Rate for Payer: PHP Commercial |
$38.91
|
| Rate for Payer: PHP Medicare Advantage |
$11.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.76
|
| Rate for Payer: Priority Health HMO/PPO |
$39.83
|
| Rate for Payer: Priority Health Medicare |
$11.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.67
|
| Rate for Payer: Railroad Medicare Medicare |
$11.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.29
|
| Rate for Payer: UHC Core |
$38.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.45
|
| Rate for Payer: UHC Exchange |
$11.45
|
| Rate for Payer: UHC Medicare Advantage |
$11.45
|
| Rate for Payer: VA VA |
$11.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.34
|
|
|
HC INJECTION, LINCOMYCIN HCL, UP TO 300 MG
|
Facility
|
IP
|
$45.78
|
|
|
Service Code
|
CPT J2010
|
| Hospital Charge Code |
63600099
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.76 |
| Max. Negotiated Rate |
$41.20 |
| Rate for Payer: Aetna Commercial |
$38.91
|
| Rate for Payer: BCBS Trust/PPO |
$37.37
|
| Rate for Payer: BCN Commercial |
$35.38
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Commercial |
$39.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Healthscope Commercial |
$41.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: Nomi Health Commercial |
$37.54
|
| Rate for Payer: PHP Commercial |
$38.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.76
|
| Rate for Payer: Priority Health HMO/PPO |
$39.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.29
|
| Rate for Payer: UHC Core |
$38.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.34
|
|
|
HC INJECTION LUMBAR DISKOGRAPHY
|
Facility
|
OP
|
$2,349.53
|
|
|
Service Code
|
CPT 62290
|
| Hospital Charge Code |
36100282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$558.01 |
| Max. Negotiated Rate |
$2,114.58 |
| Rate for Payer: Aetna Commercial |
$1,997.10
|
| Rate for Payer: Aetna Medicare |
$610.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$734.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$734.23
|
| Rate for Payer: BCBS Complete |
$939.81
|
| Rate for Payer: BCBS MAPPO |
$587.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,931.55
|
| Rate for Payer: BCN Commercial |
$1,826.76
|
| Rate for Payer: BCN Medicare Advantage |
$587.38
|
| Rate for Payer: Cash Price |
$1,879.62
|
| Rate for Payer: Cofinity Commercial |
$2,020.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,879.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$587.38
|
| Rate for Payer: Healthscope Commercial |
$2,114.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,762.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$616.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$675.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,997.10
|
| Rate for Payer: Nomi Health Commercial |
$1,926.61
|
| Rate for Payer: PACE Senior Care Partners |
$558.01
|
| Rate for Payer: PACE SWMI |
$587.38
|
| Rate for Payer: PHP Commercial |
$1,997.10
|
| Rate for Payer: PHP Medicare Advantage |
$587.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,527.19
|
| Rate for Payer: Priority Health HMO/PPO |
$2,044.09
|
| Rate for Payer: Priority Health Medicare |
$593.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,574.19
|
| Rate for Payer: Railroad Medicare Medicare |
$587.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,067.59
|
| Rate for Payer: UHC Core |
$1,961.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$587.38
|
| Rate for Payer: UHC Exchange |
$587.38
|
| Rate for Payer: UHC Medicare Advantage |
$587.38
|
| Rate for Payer: VA VA |
$587.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,762.15
|
|
|
HC INJECTION LUMBAR DISKOGRAPHY
|
Facility
|
IP
|
$2,349.53
|
|
|
Service Code
|
CPT 62290
|
| Hospital Charge Code |
36100282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,527.19 |
| Max. Negotiated Rate |
$2,114.58 |
| Rate for Payer: Aetna Commercial |
$1,997.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,917.92
|
| Rate for Payer: BCN Commercial |
$1,815.72
|
| Rate for Payer: Cash Price |
$1,879.62
|
| Rate for Payer: Cofinity Commercial |
$2,020.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,879.62
|
| Rate for Payer: Healthscope Commercial |
$2,114.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,762.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,997.10
|
| Rate for Payer: Nomi Health Commercial |
$1,926.61
|
| Rate for Payer: PHP Commercial |
$1,997.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,527.19
|
| Rate for Payer: Priority Health HMO/PPO |
$2,044.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,574.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,067.59
|
| Rate for Payer: UHC Core |
$1,961.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,762.15
|
|
|
HC INJECTION, MEDROXYPROGESTERONE ACETATE, 1 MG
|
Facility
|
OP
|
$1.04
|
|
|
Service Code
|
CPT J1050
|
| Hospital Charge Code |
63600096
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Aetna Commercial |
$0.88
|
| Rate for Payer: Aetna Medicare |
$0.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.33
|
| Rate for Payer: BCBS Complete |
$0.42
|
| Rate for Payer: BCBS MAPPO |
$0.26
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.81
|
| Rate for Payer: BCN Medicare Advantage |
$0.26
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Cofinity Commercial |
$0.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.26
|
| Rate for Payer: Healthscope Commercial |
$0.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.88
|
| Rate for Payer: Nomi Health Commercial |
$0.85
|
| Rate for Payer: PACE Senior Care Partners |
$0.25
|
| Rate for Payer: PACE SWMI |
$0.26
|
| Rate for Payer: PHP Commercial |
$0.88
|
| Rate for Payer: PHP Medicare Advantage |
$0.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.68
|
| Rate for Payer: Priority Health HMO/PPO |
$0.90
|
| Rate for Payer: Priority Health Medicare |
$0.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.70
|
| Rate for Payer: Railroad Medicare Medicare |
$0.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.92
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.26
|
| Rate for Payer: UHC Exchange |
$0.26
|
| Rate for Payer: UHC Medicare Advantage |
$0.26
|
| Rate for Payer: VA VA |
$0.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.78
|
|
|
HC INJECTION, MEDROXYPROGESTERONE ACETATE, 1 MG
|
Facility
|
IP
|
$1.04
|
|
|
Service Code
|
CPT J1050
|
| Hospital Charge Code |
63600096
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Aetna Commercial |
$0.88
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.80
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Cofinity Commercial |
$0.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.83
|
| Rate for Payer: Healthscope Commercial |
$0.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.88
|
| Rate for Payer: Nomi Health Commercial |
$0.85
|
| Rate for Payer: PHP Commercial |
$0.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.68
|
| Rate for Payer: Priority Health HMO/PPO |
$0.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.92
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.78
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 20 MG
|
Facility
|
IP
|
$10.40
|
|
|
Service Code
|
CPT J1020
|
| Hospital Charge Code |
63600093
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Aetna Commercial |
$8.84
|
| Rate for Payer: BCBS Trust/PPO |
$8.49
|
| Rate for Payer: BCN Commercial |
$8.04
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$8.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Healthscope Commercial |
$9.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: Nomi Health Commercial |
$8.53
|
| Rate for Payer: PHP Commercial |
$8.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.76
|
| Rate for Payer: Priority Health HMO/PPO |
$9.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.15
|
| Rate for Payer: UHC Core |
$8.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.80
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 20 MG
|
Facility
|
OP
|
$10.40
|
|
|
Service Code
|
CPT J1020
|
| Hospital Charge Code |
63600093
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Aetna Commercial |
$8.84
|
| Rate for Payer: Aetna Medicare |
$2.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.25
|
| Rate for Payer: BCBS Complete |
$4.16
|
| Rate for Payer: BCBS MAPPO |
$2.60
|
| Rate for Payer: BCBS Trust/PPO |
$8.55
|
| Rate for Payer: BCN Commercial |
$8.09
|
| Rate for Payer: BCN Medicare Advantage |
$2.60
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$8.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.60
|
| Rate for Payer: Healthscope Commercial |
$9.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: Nomi Health Commercial |
$8.53
|
| Rate for Payer: PACE Senior Care Partners |
$2.47
|
| Rate for Payer: PACE SWMI |
$2.60
|
| Rate for Payer: PHP Commercial |
$8.84
|
| Rate for Payer: PHP Medicare Advantage |
$2.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.76
|
| Rate for Payer: Priority Health HMO/PPO |
$9.05
|
| Rate for Payer: Priority Health Medicare |
$2.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.97
|
| Rate for Payer: Railroad Medicare Medicare |
$2.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.15
|
| Rate for Payer: UHC Core |
$8.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.60
|
| Rate for Payer: UHC Exchange |
$2.60
|
| Rate for Payer: UHC Medicare Advantage |
$2.60
|
| Rate for Payer: VA VA |
$2.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.80
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
|
Facility
|
IP
|
$15.61
|
|
|
Service Code
|
CPT J1030
|
| Hospital Charge Code |
63600094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$14.05 |
| Rate for Payer: Aetna Commercial |
$13.27
|
| Rate for Payer: BCBS Trust/PPO |
$12.74
|
| Rate for Payer: BCN Commercial |
$12.06
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$14.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$12.80
|
| Rate for Payer: PHP Commercial |
$13.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: Priority Health HMO/PPO |
$13.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.74
|
| Rate for Payer: UHC Core |
$13.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.71
|
|
